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Treatments[edit]

Cauda Equina Syndrome, also known as CES, is a disease in which a nerve or nerves of the back starting from the end of spinal cord to the base of the vertebral column are compressed. Due to the debilitating nature of this disease, immediate treatment is necessary. Two categories of treatment that have shown the best outcomes of CES include; surgical decompression and vasodilation. ([1]).

Surgical Decompression[edit]

Surgical decompression is the treatment that is known for having the best outcomes ([2]). It is a surgical procedure in which the pressure from the pinched nerve or nerves is released. This involves decompression to allow maximum neurological recovery ([3]). Surgery has better outcomes with neurological recovery, than patients who go through nonsurgical treatments. Timing of surgery is significant for maximum recovery ([4]). It is recommended surgery occurs within 48 hours of the beginning symptoms of severe low back pain, muscle weakness in the lower extremities, and loss of bowel control ([5]).

The common decompression surgeries for CES victims are lumbar laminectomy along with a lumbar discectomy. Lumbar laminectomy takes out the lamina that is associated with the location of the pinched nerve, allowing an opening (Fig.1). Lumbar discectomy, on the other hand, takes out the disc. The purpose of the procedure is to take out the compressing agent and allow the space in the spinal canal to remove the pressure on the impacted nerves ([6]).

Figure 1. This is my own image that contains an MRI of the spine from the sagittal view. The lamina is labeled above in the picture. Removal of the lamina is known as a laminectomy, which is a common procedure for CES.

Figure 1. This is my own image that contains an MRI of the spine from the sagittal view. The lamina is labeled above in the picture. Removal of the lamina is known as a laminectomy, which is a common procedure for CES.

Vasodilation[edit]

According to Orendacova, et al., ([7]) , through the effects of CES, it has been observed that along with nerve damage there is a education in blood flow at the site of injury. By widening the blood vessels, known as vasodialation, this will allow a relief in pain and numbness in the lower extremities (Orendacova, J., Cizkova, D., Kafka, J., Lukacova, N., Marsala, M., Sulla, I., et al. (2001). Cauda equina syndrome. Progress In Neurobiology, 613-637.). Vasodilation has showed positive outcomes with treatment effects lasting two and a half months. However, it has no positive outcomes on severely affected patients. ([8])

Rehabilitation[edit]

Physical therapy can be somewhat useful for patient’s recovery from surgery ([9]). The main focus of rehabilitation is centered on controlling the bladder and bowel functions and increasing muscle weakness in the lower extremities.

Bowel and Bladder Control[edit]

Rehabilitation of CES depends on the severity of the injury. If permanent damage occurs, then impairment in bladder and bowel control may result ([10] ). Once surgery is performed, resting is required until the bladder and bowel dysfunction can be assessed [11]. Urinary catheterization, which is the insertion of a tube in the bladder to allow passage of urine to collect in a bag, may help with bladder control(Hodges, 2004). Gravity and exercise can help control bowel movement (Hodges, 2004). Pelvic floor, consisting of muscles from the pubic bone to the base of the pelvis, exercises assist in controlling bowel movements (Pelvic Floor Exercises, 2010). These exercises can be done standing, lying, or on all fours with the knees slightly separated (Fig. 2). Full recovery of bowel and bladder control can take as long as two years ([12]).

Bowel and bladder control postitions

Figure 2. These are different positions to perform pelvic floor exercise. The first exercise, which is slowly tightening the muscles, should be performed 10 times for 10 seconds with a 4 second rest in between (Pelvic Floor Exercises, 2010). The second exercise, which is quickly tightening these pelvic floor muscles should be held for one second (Pelvic Floor Exercises, 2010). The patient should try to complete 10 contractions in a sequence (Pelvic Floor Exercises, 2010).

Physical Therapy[edit]

Physical therapist can assist in sitting stability, and transferring by working on strength training. Therapists will work on balance, gait, and transfers since muscle weakness or paralysis may occur in the lower extremities [13]. Additionally, electrical stimulation is also helpful to enhance muscle tone ([14]).

Cite error: There are <ref> tags on this page without content in them (see the help page).

  1. ^ Orendacova, J., Cizkova, D., Kafka, J., Lukacova, N., Marsala, M., Sulla, I., et al. (2001). Cauda equina syndrome. Progress In Neurobiology, 613-637.
  2. ^ Silvers, R. H., Lewis, J. P., & Asch, H. L. (1993). Decompressive lumbar laminectomy for spinal stenosis. Journal of Neurosurgery, 695-701.
  3. ^ Harrop, J. S., Hunt, G. E., & Vaccaro, A. R. (2004). Conus medullaris and cauda equina syndrome as a result of tramatic injuries: management principles. Neurosurgery Focus, 19-23.
  4. ^ Small, S. A., Perron, A. D., & Brady, W. J. (2005). Orthopedic pitfalls: cauda equina syndrome. American Journal of Emergency Medicine, 159-163.
  5. ^ Raj, D., & Coleman, N. (2008). Cauda Equina Syndrome secondary to lumbar disc herniation. Acta Orthopaedica Belgica, 522-527.
  6. ^ Silvers, R. H., Lewis, J. P., & Asch, H. L. (1993). Decompressive lumbar laminectomy for spinal stenosis. Journal of Neurosurgery, 695-701.
  7. ^ Orendacova, J., Cizkova, D., Kafka, J., Lukacova, N., Marsala, M., Sulla, I., et al. (2001). Cauda equina syndrome. Progress In Neurobiology, 613-637.
  8. ^ Orendacova, J., Cizkova, D., Kafka, J., Lukacova, N., Marsala, M., Sulla, I., et al. (2001). Cauda equina syndrome. Progress In Neurobiology, 613-637.
  9. ^ Kennedy, J. G., Soffee, K. E., McGrath, A., Stephens, M. M., Walsh, M. G., & McManus, F. (1999). Predictors of outcome in cauda equina syndrome. European Spine Journal, 317-322.
  10. ^ Hodges, S. D. (2004 , September). Cauda Equina Syndrome: Rehabilitation . Retrieved May 10, 2013, from eMedicine: http://www.mdguidelines.com/cauda-equina-syndrome/rehabilitation
  11. ^ Hodges, S. D. (2004 , September). Cauda Equina Syndrome: Rehabilitation . Retrieved May 10, 2013, from eMedicine: http://www.mdguidelines.com/cauda-equina-syndrome/rehabilitation
  12. ^ Hodges, S. D. (2004 , September). Cauda Equina Syndrome: Rehabilitation . Retrieved May 10, 2013, from eMedicine: http://www.mdguidelines.com/cauda-equina-syndrome/rehabilitation
  13. ^ (Dawodu, S. T. (2013, March 6). Cauda Equina and Conus Medullaris Syndromes Treatment & Management. Retrieved May 15, 2013, from EMedicine: http://emedicine.medscape.com/article/1148690-treatment#aw2aab6b6b2)
  14. ^ Dawodu, S. T. (2013, March 6). Cauda Equina and Conus Medullaris Syndromes Treatment & Management. Retrieved May 15, 2013, from EMedicine: http://emedicine.medscape.com/article/1148690-treatment#aw2aab6b6b2
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